Chapter 1

The First Step: the Endodontic Treatment

Aim

To describe the principles of root canal treatment and their impact on the subsequent restoration of the tooth.

Outcome

After reading this chapter, the reader should have a clearer understanding of the role of microbial infection in periapical disease, the rationale for each stage of root canal treatment, and the importance of a suitable post-endodontic restoration. The reader should also appreciate the impact of each stage of root canal treatment on the subsequent restoration of the tooth.

Introduction

The purpose of root canal treatment is to prevent apical periodontitis in teeth with irreversible pulpitis and to heal apical periodontitis in teeth with infected, necrotic pulp spaces. Root canal treatment allows teeth to remain in healthy, pain-free function in the dental arch, and to justify confidence and expenditure in respect of a definitive long-term restoration.

The dentine-pulp complex is protected by a hard, impermeable outer casing of enamel. Once these barriers are breached by, for example, caries, operative dentistry, tooth surface loss or trauma, the underlying permeable dentine-pulp complex becomes susceptible to microbial, chemical and/or physical injury. Injury may occur as a result of noxious stimuli reaching the pulp indirectly via patent dentinal tubules, or directly if the pulp becomes exposed to the mouth. The pulp tissue within the root canal space will become inflamed and ultimately necrotic, allowing microbial infection to progress. Eventually, this will lead to the development of periapical disease.

Patients with pain of dental origin may present with signs of pulpitis or apical periodontitis. Once a diagnosis of irreversible pulpitis or apical periodontitis has been made, the tooth should be assessed according to the guidelines in Chapter 8, and the treatment options of extraction versus root canal treatment and subsequent restoration discussed with the patient. When discussing treatment options, it is essential to advise that root canal treatment is not an end in itself, and that post-endodontic restorative treatment will be required to restore the tooth back to function and aesthetics. It should be stressed that the timing, nature and quality of the coronal restoration may have a critical bearing on endodontic success and tooth survival. Only then can an informed decision be made on the most suitable treatment for the tooth in question.

Stages of Root Canal Tre